ENROLLED
H. B. 3057
(By Delegate Perdue)
[Passed March 10, 2007; in effect ninety days from passage.]
AN ACT to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §16-2K-1 and
§16-2K-2, all relating to programs for all-inclusive care of
the elderly, known as "PACE"; setting forth legislative
intent; defining terms; and exempting "PACE" programs from
regulation by the Insurance Commissioner.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §16-2K-1 and §16-2K-2,
all to read as follows:
ARTICLE 2K. PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY,
"PACE".
§16-2K-1. Legislative findings and statement of purpose.
(a) The United States Department of Health and Human Services
has established a model of managed care service delivery that encourages innovative integrated health care delivery systems to
serve frail and disabled elders with effective primary, preventive,
restorative, supportive and palliative care. The program, as
authorized in 42 CFR §460, §462, §466, §473 and §476, provides for
the establishment of local programs to reorganize and reintegrate
local health care delivery systems.
(b) The program for all-inclusive care for the elderly or
"PACE" is a capitated program that is operated in accordance with
federal law by a public, private, nonprofit or proprietary entity
to provide comprehensive health and social services to disabled and
frail elderly persons, certified by the state as nursing home
eligible to maximize the autonomy and continued independence of
these elderly persons.
(c) The Legislature finds that the "PACE" programs will
enhance the quality of life, function and health of elderly
persons.
(d) In order to promote the expansion of medical, social and
long-term care services for the elderly, it is the intent of the
Legislature to eliminate legal, statutory and regulatory barriers
to the establishment of "PACE" programs by exempting health
providers participating in these programs from regulation as
insurers.
§16-2K-2. "PACE" program operation; exemption from regulation as
an insurer; annual reports to the Legislature.
(a) A "PACE" program may operate in this state only in
accordance with a contract with the United States Department of
Health and Human Services, which is prepared in consultation with
and approved by the West Virginia Department of Health and Human
Resources.
(b) Notwithstanding the provisions of chapter thirty-three of
this code to the contrary, participation by providers in a "PACE"
program created and authorized pursuant to this article is not
considered as providing insurance or as offering insurance
services, and "PACE" providers and services are specifically
excluded from the definitions of "insurer" and "insurance" as
defined in article one, chapter thirty-three of this code, and from
the definition of "health maintenance organization" as defined in
article twenty-five-a of this code. Participating "PACE" providers
are not unauthorized insurers pursuant to section four, article
forty-four of chapter thirty-three of this code. These "PACE"
programs are not subject to regulation by the Insurance
Commissioner except to the extent set forth in this article.